Clinton’s budget proposal:
What does it means to health professionals?
On Feb. 6, President Bill Clinton presented his budget proposal for the 1998 fiscal year to Congress and took the first step in the long process of eliminating federal deficits by 2002. Although Republicans support the idea of balancing the budget, they and Clinton have different proposals for doing it. Republicans want deeper tax cuts, less federal spending, and more power shifted from Washington to the states than Clinton prefers. Outlined below are some of the proposed budget’s implications for healthcare professionals.
MEDICARE
The president proposes cutting $100 billion from Medicare over five years, and reimbursement rates for HMOs and hospitals are targeted for much of the cuts. Payments to HMOs are reduced by $34 billion and payments to hospitals, $33 billion. Although Stephanie Reed, assistant director of federal government relations at the American Nurses Association (ANA) in Washington, is still analyzing the proposed budget, she is distressed by cuts planned for Medicare Part A, which reimburses hospitals for beneficiaries’ inpatient care. “The problem is where is the hospital going to go for savings? Will they reduce RN staffing and change the staffing mix? There needs to be some protections offered for patients’ safety and to ensure quality of care,” she said.
Reed’s attention was also piqued by the proposal to allow provider-sponsored organizations to operate as Medicare managed care plans. Her concern is that physicians may organize and exclude other health practitioners. “It depends on how it is done,” she said.
Nurse practitioners, physician assistants, and clinical nurse specialists fared better than HMOs and hospitals in the proposal, which would provide direct Medicare reimbursement to all NPs, PAs, and CNSs working in home and ambulatory care settings beginning in 1998.
Also, beneficiaries would be covered for several preventive services, including mammograms, diabetes management training, and colon cancer screening. They would pay less for outpatient surgery, and families of beneficiaries with Alzheimer’s disease would be eligible for a respite benefit.
NURSING EDUCATION
In addition to the proposed cuts for Medicare, the ANA opposes the budget's massive cutback in funding for nursing education. Budgeted at $63 million for the current fiscal year, nursing education would be hacked to $7.7 million for next year. The Nurse Education Act, funded under Title VIII of the Public Health Service Act, provides federal support to mostly advanced practice programs.
“Reports from both the Institute of Medicine and from the Pew Commission say we need more advanced practice nurses. What has changed in health care to warrant this?” said Rose Gonzalez, RN, ANA assistant director of federal government relations and the group’s point person on nursing education funding.
“We are extremely disappointed by the president’s budget proposal. Without stable funding to support graduate-level education for nurses, we’ll enter the 21st century ill-prepared to provide adequate health care to aging baby boomers and their grandchildren,” said ANA President Beverly Malone, PhD, RN, FAAN.
And Gonzalez doesn’t see this cut as a means of balancing the budget. In the scope of a $1.69 trillion budget, the savings is “budget dust,” she said. Education for primary care and for allied health professions is also slated for a 90 and 56 percent cut, respectively.
MEDICAID
The budget proposal would cap the amount that can be spent on each Medicaid recipient. Much of the cost savings would pay for the costs of other new healthcare initiatives, including the programs to extend health care coverage to 5 million of the 10 million uninsured children by the end of the President’s term in 2000. However, meeting this goal may only be a matter of expanding Medicaid enrollment outreach. “There are already 3 million children eligible for Medicaid, but not on the rolls,” said Reed.
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